Memorandum of Agreement

Physician health and safety: PMA Memorandum of Agreement

Ensuring the physical and psychological safety of doctors in their workplaces is imperative in order to provide the best care possible to patients. To this end, Doctors of BC has taken significant action to improve workplace safety through the Memorandum of Agreement on Physical/Psychological Safety (now referred to as the Physician Health and Safety Agreement). Incorporated into the 2019 Physician Master Agreement, this Agreement makes it so that physicians have the opportunity to be included in widespread systemic change to better support physical and psychological health and safety in the workplace. It is also the first agreement of its kind in Canada and the first time Doctors of BC has worked with the Ministry of Health, the Health Employers Association of BC, health authorities, and health care related bargaining associations on issues specific to physician safety. 

What members told us

Doctors of BC is acutely aware of physical and psychological safety concerns in the physician workplace. In our 2021 Health Authority Engagement Survey - What We Heard Report, half of respondents indicated they believe effective actions are not being taken to promote a healthy and safe workplace. And in our 2021 Health Authority Engagement Survey, two key issues stood out:  

Improving physician health and safety in the workplace

What are the goals of the Physician Health and Safety Agreement?

The ultimate goals of the Agreement are to:

• strengthen relationships between Doctors of BC, Medical Affairs departments, and Occupational Health and Safety departments within health authorities to better support physicians in their workplaces
• provide structures and mechanisms to represent physicians in these matters, including the opportunity to influence policy and decision making at both the provincial and regional level
• enhance processes and communications around all aspects of physician health and safety, more specifically by ensuring transparency and feedback loops when raising issues without fear of reprisal

 

How does the Physician Health and Safety Agreement address safety in the workplace?

The Agreement has established a number of new regional and provincial committees, structures, and working groups focused specifically on enhancing and improving physical and psychological health and safety in the workplace. It aims to accomplish this by supporting activities that enable consistent policies and procedures for physician specific occupational health and safety issues including: exposure management, contact tracing, enabling feedback loops, and more. The Agreement also provides funding for the following committees, structures, and Working Groups to begin activities that support physician health and safety. 

Structures:

• SWITCH BC – an independent, provincial non-profit whose role is to lead and support provincial, systemic improvements in the health, safety, and well-being of all healthcare workers. The governance model is unique in BC and Canada, with a Board of Directors comprised of representatives from all health sector bargaining associations, Doctors of BC, the Health Employers Association of British Columbia (HEABC), and the Ministry of Health.

Committees and Working Groups: 

• Physician Specific Issues Working Group: a joint provincial committee/working group between the Ministry of Health, health authorities, Health Employers Association of BC (HEABC), and Doctors of BC, whose purpose is to help inform the BC Health Care Occupational Health and Safety Society, as well as identify and discuss regional-level issues to ensure consistency across the province. 
• Physician Health & Safety Advisory Group: an internal group comprised of Doctors of BC physician representatives and Doctors of BC staff who aims to provide updates to and plan/prioritize ideas for the Physician Specific Issues Working Group and each Regional Working Group.
• Regional Physician Health and Safety Working Groups: established within each Health Authority and comprised of Doctors of BC physician representatives, Regional Advisors and Advocates, and staff from Health Authority Medical Affairs and the Occupational Health and Safety department, the purpose of these groups is to build relationships, identify and discuss new opportunities for physician input, and develop activities, projects, and initiatives related to physician health and safety that can be funded under the Agreement.

Current work under the Physician Health and Safety Agreement

A number of regional and provincial projects and activities are underway that seek solutions to creating systemic change and that create opportunities for physicians to raise and provide input into health and safety issues and processes. Here is a list by Health Authority:

Fraser

• Blood or Body Fluid (BBF) Exposure Follow-up and Support Project: This project aimed to ensure that Fraser Health Medical Staff had the opportunity to consult with an Occupational Health Nursing professional for guidance, risk assessment, and recommendations after an occupational Blood and Body Fluid exposure. Read the final report. 
• Leadership Coaching Pilot Project: The pilot project aims to help leaders deepen their awareness and effectiveness, identify challenges and opportunities more clearly, build resilience, and expand their “systems” perspectives – all of which is critical for ensuring that high-quality patient care is delivered. Read the final report.
• Patient Voices & Psychological Safety: The inclusion of patient partners in improving healthcare is critical to all future health system improvement strategies. Through this project, it was felt the voice of end-users of the health system may be helpful in setting up some conditions for a shift in healthcare culture and was done so via an online focus group discussion. Read the final report.
• Project Lead and Analyst Support Roles: It was identified that continuing support is needed to help advance the work and project infrastructures in the region to ensure success and timely completion of both ongoing and future projects. Read the final report.

Interior

Interior Physician Health and Safety Working Group: this group has a number of projects underway in 2022, covering the following topics:

• Physician training and education on occupational health and safety
• Physician incident reporting and investigation
• Reporting on physician immunization and vaccination

Island

Physician Focus Group on Respectful Workplace and Disciplinary Processes: this project is intended to better understand what policies, processes, and communications are working well from a physician’s perspective when it comes to respectful workplace and disciplinary processes, as well as those that aren’t. Since these policies and processes can contribute to a reduced sense of psychological safety for physicians, and be challenging and stressful to manage for Health Authority leadership.

The goal of this project is to improve psychological safety in the workplace by addressing identified issues, and building trust and stronger relationships between medical staff and leadership. 

• In late 2020, physicians participated in small, confidential focus groups to ascertain their views on current respectful workplace and disciplinary processes, and to provide recommendations on how to improve them.
• Stemming from the information gathered, the Physician Focus Group is being formed to address the proposed recommendations. The group will be comprised of the Island Regional Physician Health and Safety physician representative, medical staff physician representatives, and representatives from Island Health and Doctors of BC.
• This project is anticipated to begin in early 2022 and is expected to be completed within twelve months.

North

Process Mapping for Incident Reporting: this project aims to implement multiple ways in which an incident can be reported, as well as outline clear expectations of the processes involved should an incident occur. An incident can be physical violence, a safety incident such as exposure or injury, or psychological safety including discipline and respectful workplace issues. Therefore, the goal of this project is to identify areas of improvement to create a more simplified pathway for physicians, medical leadership, and health authorities to report incidents, ultimately creating a more psychologically safe workplace.

• To date interviews with various stakeholder groups have been conducted, the information gathered has been analyzed, and recommendations have been drafted.
• The recommendations will now be reviewed to determine next steps.

Vancouver & Coast

Physician Occupational Safety and Health Program (POSH): this program provides occupational health services for physicians, specifically on communicable disease management. It was created in response to COVID-19 to both provide these services in a crisis and to help keep physicians safe and healthy.

• Before POSH launched on April 1, 2020, no program like it existed and there was consensus that the provision of primary, secondary, and tertiary prevention of work-related health issues was lacking.
• Since launching, POSH has served close to 3,000 physicians, as well as dentists, midwives, and the Divisions of Family Practice. It has also been instrumental in supporting the mandatory vaccination public health order.
• Over the coming months, ways to expand POSH will be piloted.

Click here to read more about the overall program.

Provincial Health Services Authority

Psychological Health & Safety Physician Education and Training: this project seeks to leverage content that was previously developed at BC Women’s and Children’s and expand training to physicians across PHSA. Training concepts would aim to operationalize clinical research and teaching practice to support a psychologically healthy and safe workplace. The following modules are currently under development:

• Just culture
• De-escalation & difficult conversations
• Conflict in the workplace
• Responding to racism in the moment
• Strategies to mitigate burnout
• Translating trauma informed principles into practice

Providence Health Care

Focus groups to identify gaps in Occupational Health & Safety processes: Facilitated by physicians for physicians, the aim of these focus groups is to identify gaps in Occupational Health and Safety processes specifically with medical staff in Providence Health Care facilities.

• The first session was conducted in December 2021 with Emergency Physicians, additional sessions may be also grouped by specialty or a mix. 

Provincial Updates

WorkSafeBC Physician Registration Guide: Doctors of BC and WorkSafeBC have updated the WSBC Physician Registration Guide to provide physicians with enhanced information on the processes and protocols for registering for WSBC coverage. The revised guide can be viewed here.

For further information specific to your region, please contact your Regional Advisor and Advocate.

Doctors of BC policy on workplace safety

Supporting BC physicians in their pursuit of workplace health and safety has become an increasingly important priority for Doctors of BC. Our work in this area includes our 2017 policy statement Promoting Psychological Safety for Physicians, our 2016 policy statement Preventing Violence in Healthcare, and local initiatives established via the Divisions of Family Practice and Medical Staff Associations.

For Doctors of BC resources on physician health and safety, please visit our Physician Health & Safety webpage.

The impact of physical and psychological safety

Physical and psychological health and safety are vital in creating safe work environments that contribute to injury prevention and that cultivate innovative, engaged, and effective teams. Physician health and safety is comprised of two components:

• physical safety, such as protecting physicians from accidents or acts of violence in the workplace, and
• psychological safety, such as bullying, harassment, discrimination, racism, and intimidation.

In the absence of psychological safety, physicians are less likely to speak up, raise patient safety issues, suggest new ideas, or ask for help when they experience any of these events, for fear of reprisal or embarrassment. Research also shows that creating a work environment in which doctors feel safe contributes to their overall well-being, and is crucial for organizational efforts aimed at reducing medical errors, improving the coordination and quality of care, and increasing cost effectiveness. 

Who do I contact if I am experiencing a safety issue?

Any physician who is experiencing issues of physical or psychological health and safety, or who has been involved or impacted by it in the past, is encouraged to contact your local Regional Advisor and Advocate.